Effect of Boarding on Mortality in ICUs

Area of Science:

• Critical Care Medicine
• Hospital Operations Research
• Patient Safety

Background:

• Hospitals utilize strategies like patient boarding to manage limited intensive care unit (ICU) bed capacity.
• Patient boarding involves admitting patients to ICUs outside their primary specialty, disrupting care team colocation and potentially exposing patients to staff with different expertise.

Purpose of the Study:

• To analyze the association between medical intensive care unit (MICU) patients boarding in alternative specialty ICUs and their risk of mortality.
• To determine if boarding critically ill patients in non-specialty ICUs impacts patient outcomes.

Main Methods:

• Retrospective cohort study utilizing instrumental variable analysis to address unmeasured confounding.
• Employed semiparametric bivariate probit estimation for the instrumental model, with propensity score matching and generalized linear modeling (GLM) as robustness checks.
• Analyzed data from a tertiary care nonprofit hospital in the US between 2002 and 2012, including all medical ICU admissions.

Main Results:

• The study included 8,429 patients, with 1,871 identified as boarders.
• Instrumental variable analysis revealed a relative risk of 1.18 (95% CI, 1.01-1.38) for ICU mortality among boarders.
• Boarding was associated with a 1.22 (95% CI, 1.00-1.49) relative risk of in-hospital mortality, with similar estimates from GLM and propensity score matching.

Conclusions:

• Patient boarding in intensive care units is associated with increased mortality.
• The findings highlight the need for further investigation into safer practices for managing patient flow during high ICU occupancy periods.
• Developing strategies to mitigate risks associated with ICU bed shortages is crucial for patient safety.